Increasing frequency of hemoglobin A1c measurements in hospitalized patients with diabetes: a quality improvement project using Lean Six Sigma
Open accessAbstract
Background: The American Diabetes Association (ADA) recommends measuring A1c in all inpatients with diabetes if not performed in the prior three months. Our objective was to determine the impact of utilizing Lean Six Sigma to increase the frequency of A1c measurements in hospitalized patients. Methods: We evaluated inpatients with diabetes mellitus consecutively admitted in a community hospital between January 2016 and June 2021, excluding those who had an A1c in the electronic health record (EHR) in the previous three months. Lean Six Sigma was utilized to define the extent of the problem and devise solutions. The intervention bundle delivered between November 2017 and February 2018 included (1) provider education on the utility of A1c, (2) more rapid turnaround of A1c results, and (3) an EHR glucose-management tab and insulin order set that included A1c. Hospital encounter and patient-level data were extracted from the EHR via bulk query. Frequency of A1c measurement was compared before (January 2016-November 2017) and after the intervention (March 2018-June 2021) using χ 2 analysis. Results: Demographics did not differ preintervention versus postintervention (mean age [range]: 70.9 [18-104] years, sex: 52.2% male, race: 57.0% white). A1c measurements significantly increased following implementation of the intervention bundle (61.2% vs 74.5%, P < .001). This level was sustained for more than two years following the initial intervention. Patients seen by the diabetes consult service (40.4% vs 51.7%, P < 0.001) and length of stay (mean: 135 hours vs 149 hours, P < 0.001) both increased postintervention. Conclusions: We demonstrate a novel approach in improving A1c in hospitalized patients. Lean Six Sigma may represent a valuable methodology for community hospitals to improve inpatient diabetes care.
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Incorporating A1C into the glucose management order set may help increase frequency of A1C testing.
“Incorporating A1C into the glucose management order set may help increase frequency of A1C testing (6).”
From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [6]
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16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026
American Diabetes Association Professional Practice Committee for Diabetes*, Bajaj, M., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Briggs Early, K., ChallaSivaKanaka, S., et al. (2026) · Diabetes Care · doi:10.2337/dc26-s016 · Cited by 80 · see citing works
- Authors
- Khan, S. A., Demidowich, A. P., Tschudy, M. M., Wedler, J., Lamy, W., Akpandak, I., Alexander, L. A., Misra, I., Sidhaye, A., Rotello, L., & Zilbermint, M.
- Affiliations
- University of Maryland, Baltimore (US)
- Johns Hopkins University (US)
- Suburban Hospital (US)
- Corresponding author
- Khan, Sara Atiq
- ORCID
- Venue
- Journal of Diabetes Science and Technology
- Publisher
- SAGE Publications
- Published
- 2023-02-14
- Volume
- 18
- Issue
- 4
- Pages
- 866-873
- ISSN
- 1932-2968 (ISSN-L)
- PMC
- PMC11307218
- OpenAlex
- W4320856606
- Cited by
- 3
- References
- 3
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1
- FWCI
- 0.67
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Diabetes Science and Technology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Johns Hopkins University
- Topics
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- HbA1c, diabetes mellitus, hospitalized patients, Lean Six Sigma, quality improvement, inpatient diabetes management, glycemic control, electronic health records, provider education, community hospitals
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Blood Glucose, Diabetes Mellitus, Female, Glycated Hemoglobin, Hospitalization, Hospitals, Community, Humans, Inpatients, Male, Middle Aged, Total Quality Management, Young Adult, Electronic Health Records, Quality Improvement
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